179 Journal of Digestive Diseases 2007; 8; 179– 185 doi: 10.1111/j.1443-9573.2007.00304.x Blackwell Publishing Asia Melbourne, Australia CDD Chinese Journal of Digestive Diseases 1443-9611 © 2007 The Authors Journal compilation © 2007 Chinese Medical Association Shanghai Branch, Chinese XXX Review Article Gastrointestinal disease in the Asia–Paciﬁc KL Goh Changing trends in gastrointestinal disease in the Asia–Paciﬁc region KL GOH Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia The new millennium has seen distinct changes in the pattern of gastrointestinal disease in the Asia–Paciﬁc region. These changes are important as more than half of the world’s population come from the region and therefore impact signiﬁcantly on the global disease burden. The highest incidence of gastric cancer (GCA) has been reported from Asia and GCA remains a very important cancer. However time-trend studies have shown a decrease in GCA incidence in several countries in Asia. A rise in cardio-esophageal cancers as seen in the West has not been reported. On the other hand, colorectal cancer has been steadily increasing in Asia with age-standardized incidence rates of some countries approaching that of the West. The pattern of acid-related diseases has also changed. Gastroesophageal reﬂux disease is a fast emerging disease with an increasing prevalence of reﬂux esophagitis and reﬂux symptoms. The prevalence of peptic ulcer disease has at the same time declined in step with a decrease in H. pylori infec- tion. Many of the changes taking place mirror the Western experience of several decades ago. Astute observation of the epidemiology of emerging diseases combined with good scientiﬁc work will allow a clearer understanding of the key processes underlying these changes. With rapid modernization, lifestyle changes have been blamed for an increase in several diseases including gastroesophageal reﬂux disease, nonalcoholic fatty liver disease and colorectal cancer. A worrying trend has been the increase in obesity among Asians, which has been associated with an increase in metabolic diseases and various gastro- intestinal cancers. Conversely, an improvement in living conditions has been closely linked to the decrease in GCA and H. pylori prevalence. KEY WORDS: colorectal cancer, gastric cancer, gastroesophageal reﬂux disease, Helicobacter pylori, peptic ulcer disease, time trends. INTRODUCTION More than half the world’s population or approxi- mately 4 billion people live in Asia. Changes in trends of disease in Asia would therefore impact signiﬁcantly on the global heath burden. Major changes in disease and health is inevitable in the Asia–Paciﬁc region as a result of dramatic socio-economic changes in the region and concomitant lifestyle changes. For all diseases, an increased prevalence could be due to better diagnosis as well as a true increase in the frequency of disease. Observations of a decrease in disease prevalence are interesting and important as well. The changing epidemiology of a disease often provides valuable insights as to possible pathogenic mechanisms and the changing epidemiology in Asia allows us an opportunity to make such observations. The purpose of this review is to study and summarize the changes that have taken place in the epidemiology of major gastrointestinal diseases: gastric cancer (GCA) and colorectal cancer (CRC), as well as that of acid-peptic Correspondence to: KL Goh, Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur. Malaysia. Email: klgoh56@tm.net.my This article is a write-up of a State of the Art Lecture presented by Professor KL Goh at the Asian Paciﬁc Digestive Week 2005, held in Seoul, Korea from 25th–28th September 2005  2007 The Author Journal compilation  2007 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology and Blackwell Publishing Asia Pty Ltd.